If you are diagnosed with HIV, you will be referred to an HIV clinic. You will also be offered counselling.
As part of your treatment, you will undergo regular blood tests. The tests are used to measure two things:
- your CD4 count, which is the number of CD4 cells in your blood
- your viral load, which is the amount of HIV in your blood
These tests allow the staff at the HIV clinic to see how far the disease has progressed and to judge the likelihood that you will develop an HIV-related infection.
As a general rule:
- A CD4 count of 500 or above means that there is no risk of HIV-related infection.
- A CD4 count of less than 200 means that there is high risk of serious HIV-related infection.
The viral load will be regularly measured to show whether the medicines being used to treat HIV are working effectively. The aim of treatment is to reduce the levels of virus in the blood (viral load) to undetectable levels. If you have a detectable viral load while taking treatment, you may need a new combination of medicines.
Both CD4 count and viral load will naturally change with time, so one high or low reading does not automatically mean that your condition has got worse. The general trend of your CD4 count and viral load over time is more important in tracking the progression of the condition.
There is no cure or vaccine for HIV. However, combination therapy, also called highly active antiretroviral therapy (HAART), slows the progression of the condition and can prolong life. A combination of medicines is used because HIV can quickly adapt and become resistant to one single medicine. HIV medicines are known as antiretrovirals (ARVs).
It is normally recommended that you begin treatment with ARVs if your CD4 count drops below 350.
For a small number of people, treatment may start before the CD4 count drops below 350. This may be recommended by your doctor if:
- You have an AIDS diagnosis (for example, Kaposi's sarcoma) or any other HIV-related illness.
- You have hepatitis B infection and it needs to be treated.
- You have a hepatitis C infection.
- You have a high risk of heart attack or stroke (cardiovascular events).
- You are pregnant and need to prevent your unborn child from becoming infected with HIV.
If treatment is not started immediately after diagnosis, your condition will be monitored and regular CD4 counts will be taken.
Many different types of ARV medicine can be used as part of your therapy. A combination of medicines that suits one person may not be suitable for another, so the medicine you take will be individual to you. There are five main types of ARV:
- nucleoside reverse transcriptase inhibitors (NRTIs) or nucleotide reverse transcriptase inhibitors (NtRTIs)
- non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- protease inhibitors (PIs)
- fusion and entry inhibitors
- integrase inhibitors (INIs)
These medicines work in different ways, but they all stop the virus reproducing inside your cells, slowing down its spread and protecting your immune system.
Most people with HIV are initially recommended to take two types of NRTI/NtRTI medication, plus another type of medicine. The two NRTI/NtRTIs are often combined in a single tablet.
The goal of treatment is to find the best combination of medicines, which reduces the viral load to undetectable levels while minimising any side effects.
In some people, the medicines that are used to treat HIV will cause side effects. However, often the side effects improve after a few weeks as your body gets used to the medicines. Common side effects of HIV medication include:
- skin rashes
- mood changes
- gaining fat on one part of your body while losing it on another (lipodystrophy)
If the side effects from HIV treatment adversely affect your quality of life, tell the staff at your HIV clinic. It may be possible to change your medicines or other medicines may be available to relieve any side effects.
The medicines used to treat HIV are only effective when taken exactly as prescribed. Missing even a few doses will increase the risk of your treatment not working.
Sticking to your treatment plan is known as adherence. To adhere to treatment, you need to:
- take the medicine at the recommended time
- take the recommended dose
- follow all instructions regarding diet, for example some medicines should only be taken on an empty stomach, while others need to be taken with food
You will need to develop a daily routine to fit your treatment plan around your lifestyle. The staff at your HIV clinic can give you advice and support.
Many of the medicines used to treat HIV can react in unpredictable ways if you take other types of medicines. These include herbal remedies such as St John's Wort, recreational drugs such as cocaine, and over-the-counter medicines.
Always check with clinic staff or your GP before taking any other medicines.
Post exposure prophylaxis (PEP)
It is sometimes possible to halt the development of HIV in the first 72 hours after exposure. This is known as post exposure prophylaxis (PEP). PEP involves taking anti-HIV medicines for four weeks.
PEP is often used when a person knows they have been exposed to HIV. This could be because they had sex with someone who they knew had HIV and the condom broke, or they were accidentally stabbed with an HIV-infected needle.
PEP is not guaranteed to work and the medicines that are used cause some unpleasant side effects, such as nausea, vomiting, diarrhoea and headaches.
If you are concerned that you have been exposed to HIV, immediately contact your local accident and emergency department or GUM (genitourinary) or sexual health clinic.